PMT17-00660 City of Menifee Permit No.: PMT17-00660
29714 HAUN RD. Type: Residential Plumbing
'5A—CCEU MENIFEE, CA92586
4n11 1xMl"— MENIFEE Date Issued: 0 310 2/2 01 7
PERMIT
Site Address: 27201 LAVENDER ST, MENIFEE,CA Parcel Number: 331-462-030
92585 Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
MATTHEW BENSON A R S AMERICAN RESIDENTIAL SERVICES OF
27201 LAVENDER STREET CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S INC DBA RESCUE ROOTER
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount f51
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 4.15
$115.16
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Pernit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby.affirm under penalty of perjury that I am under provisions of with a licensed contractar(s)pursuant to the Contractors State License Law).
Chapter9(commencingwith section 7000)of Division 3 of the Business and o I am exempt from licensure underthe Contractors State License Lawfor
Professions Code and my license is in full force and effect. the following reason:
License Cl pp license No By my signature below I acknowledge that,except for my personal residence
Expi Signature in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that 1
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Cade,for the performance of work for which www.IegInfo.ca.Roy/caIaw.htmL
permit is issued.
Policy H Date
,7,L have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which D mysignature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy caner arauthorized to act on the property owner's behalf.I have read this
numberare application and the information I have provided is correct.I agree to comply
Carrier � with all applicable city and coun nances and state laws relating to
building stru d0q.Iauth representatives of this city or county to
Policy# 4: d Expires rrp enterth den0fi95 erty for inspection purposes.
(This section need not to be completed is the permit is f r one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
,"'1'rertify that in the performance of the work for which this permit is issued,
- I shall not employ any perso m any manner! to become subject to the CITY BUSINESS LICENSE It
workers compensation s of 501 nia,a gree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wor s com � ion ' Ions of Section 3700 ofth Labor
Cade,)shall fo ith wit rov ions. Will the applicant or future building occupant handle hazardous material or
Applicant Date 6 �.{ mixture containing a hazardous material equal to or greater thatthe
amounts spe fled on the Hazardous Materials Information Guide?
WARNING:FAILURETO SE[UREWORKER'SCOMPENSATIO COVERAGE IS oYes No
UNLAWFUL,AND SHALLSUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building bythe applicant orfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY oyes �o
1 hereby affirm that under the penalty of perjury there is a construction - Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Cade) o Yes r�Ao
OWNER BUILDER DECLARATIONS I have read the Hazardou aterial Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist. nders my require under the State of
California Heait Safe de,Section and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous eria rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 � a �F
Business and Professions Code).Any city or county that requires a permit to Date—
construct,alter,improve,demolish or repair any structure,prior to its ROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRP)
License Law(Chapter 9(commencing with Section 700D)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This Includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o I,as owner of the property,or my employee with wages as their sale employees.For more Information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead/lead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a in An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project bemuse:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
'Menifee
DATE 3 ,2 17 PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION []ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
[]NEW E]ITL-UMBING [:IRE-ROOF-NUMBER OF SQUARES
-
DESCRIPTION DESCRIPTION OF WORK F`� CC 6Z2o Gk�'f G'S jai ��� /N �•'a�1 City of Menif e
L u Dept.
PROJECT ADDRESS C2-V D/ L0VfHA1AI $ 37
,�
ASSESSOR'S PARCEL NUMBER S,-NL,a'� LOT TRACT --'cGiv d
OWNER NAME Al'14,aa 2�--mOq
ADDRESS ,�QG'li>99d Q'� OAS lf�
PHONE fa/f<a a739 EMAIL
APPLICANT NAME AII`A' d7/
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME k- Adg- OWNER BUILDER? ❑YE NO
BUSINESS NAME / J
ADDRESS Jp-o T^/ l//�n S� ✓>l1�Sl��
PHONE 9573y1,0 Z1 EMAIL
CONTRACTOR'S STATE LIC NUMBER /(0 40 d5 J LICENSE CLASSIFICATION 63 E-
VALUATION$ SQ F — L SO FT
APPLICANT'S SIGNATURE DATE 3�2- 17
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT -,
AMOUNT 0CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofrnenifee.us Inspection Request Line 951-246-6213
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